MERS: Serious but Not an Emergency

The Middle East coronavirus (MERS) remains a serious concern but is still not a global public health emergency, a World Health Organization (WHO) committee decided Monday.

One reason for that is that the recent upsurge in cases has "significantly decreased," according to Keiji Fukuda, MD, the agency's assistant director-general for health security.

That's likely because the surge was primarily related to transmission in hospitals, which has been tamped down by improved infection prevention and control measures, Fukuda told reporters in a telephone briefing from Geneva after the sixth meeting of the WHO's MERS emergency committee.

Equally important, there is still no evidence of sustained transmission of MERS in the community, although the "gorilla in the room" is whether the virus can develop that capacity, Fukuda said.

Meanwhile, the CDC is reporting that the two U.S. cases -- in Indiana and Florida -- did not pass the virus to any of their family members or to any of the healthcare workers who treated them.

The two cases were not related, although both involved healthcare providers who lived and worked in Saudi Arabia, which has been the center of the outbreak and is where the two are thought to have been infected.

As part of the investigation, the CDC collected specimens from household members and healthcare workers who had close contact with the two patients. All the specimens tested negative for both active and previous MERS infection, the agency reported.

The results among the contacts "considered at highest risk for ... infection are reassuring," David Swerdlow, MD, who is leading the agency's response to the outbreak, said in a statement.

Additionally, health officials in the U.S. and abroad have reached almost all of the people who traveled with the patients, and so far none have had evidence of being infected.

The CDC said the investigation of travel contacts is ongoing and the situation could change.

In Geneva, Fukuda said the emergency committee, consisting of WHO officials, experts, and representatives of countries with recent cases, met by telephone to discuss what has changed since the last meeting just under a month ago.

The committee agreed unanimously that the situation is not a "public health emergency of international concern" although it is still worrisome, "especially given the anticipated increase in travel to Saudi Arabia" related to important pilgrimages such as the Hajj this fall.

One key finding, Fukuda said, is that most of the recent cases in Saudi Arabia were associated with healthcare.

"Many of the cases that were thought to have occurred in the community are really related to infections occurring in hospitals," he said, primarily because of "suboptimal infection prevention and control measures."

Fukuda said the emergency committee is convinced that there has been significant improvement in such measures in Saudi Arabia, which has led to the slowdown in new cases reported there.

Over the past eight days -- from June 10 through 17 -- only four cases have been reported by the Saudi health ministry, a far cry from the 61 reported from May 10 through 17.

Fukuda said "basic" infection control measures, such as hand hygiene, are enough to control the virus. "We do not believe that esoteric or unusual measures are needed," he said. Esoteric measures might include such things as hospital rooms with negative pressure, he added.

Fukuda noted that among the questions still open about the recent surge in cases is exactly where infection control in Saudi Arabia fell down.

In addition, he said, there is a "growing sense" that camels are an important source of exposure to the virus, but it's not clear exactly how the virus travels from the animals to humans.

All told, Fukuda said, the WHO has been officially informed of 701 laboratory-confirmed cases worldwide including 249 deaths, for a 36% case-fatality rate. Those numbers differ from other sources -- Saudi Arabia alone is reporting 704 cases and 289 deaths -- largely because of reporting delays, Fukuda said.

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